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I <br />.IiNG.INSPECTOR RECORD <br />COMTlENTSAPPROVALSDATE!D/SIG. <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Gas-Underf loor <br />Buildinq Sewer <br />Area/Storm Drain <br />I nterceptor/ Clarif ier <br />TOP OUT <br />Waste & Vent <br />Water Pipinq <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouqh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Pipino <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitarv Sewer/Cap <br />Back Flow Device <br />Rouqh Plumbinq <br />Final Gas Test <br />Meter Release <br />FINAL 2 14 70 Dtkrrl tz uW t7 <br />Notes, Remarks, Etc lr <br />()IVN1.]R BUII,DI.]R DI.:I,(:ARA'IIoN <br />I hcrchy rllirill undcr pcnrlly ol pciury lhat I rm cxctrrpl ti1)m thc Conlrrclors' l-iccnsc lrw for lhc li)lk]win8 rcrsol (Scc.70.ll.5 <br />llusincss anl Prolt\{ion Codc): Any Cily or Counly which rcqnirc{ il frrmil to con\truct. altcr. inrprovc. dctrrclish or rcpilir any <br />slnlcturc.nd()rloils issuarre.rlsorequircslhcrpplicrnlf()rsuchpcrililtolilcasigncdslttcmcnt thtlhcorshcisliccn\cd l)ursutnl <br />tr lhc l)rovisi()n\ ol lhc Conlrrclor's Liccnscd l-a*' (('hrplcr 9. (i)rnnlcNing \\'ilh Scclion 7(XX) ol Divi\bn J o[ lhc lrusinc\\ iln(l <br />ll'oltssiotrsCodc)orthrlhcorshciscxcnrplthcrclioillx[dthcbilsisl'orlhc0llcgcdcxcmplion. AnyviolalkrnofScctionT03l.5byany <br />npplicrnlli)rxpcrnrilsuhjccl\lhc npplicrnlhucivilpcnallyofilililx)rclhatrlitchuntlrcddollars(S5fi)). <br />-1. <br />as owrer of lhc pmpcny. or my emplolecs wilh wages as their $le ompcnsation. will do orc so* and the slnrt@ Ls ml <br />intcndcd or oflbrcd for salc (Ss.7044, Busincss and hofessions Codc: Thc Crntractor's Liccnse Law does not apply to an owncr of <br />lhc pm[Eny who h.rilds or inqrmvc themn. ard who des sch work himsclf or herslf or thmugh his or hcr own cmployecs. <br />provided lhat such impmvcmnts @ mt inlcndc{ or offercd for slc. If. howcvfi. lhc buikling or inDrewmnt is mh whhin om }rcr <br />ofcomphtion. thc Owncr Buill,cr will havc Ihc burden ofprevinS that hc or shc did ml build or improvc thc pmlEty for the pur[Drc of <br />mlc). <br />-1. <br />ds owncr of the propcny. an cxclusivcly conlraclinS s'ith liccilqcd conlraclon lo construcl lhc p(+cl (Scc. 7(11.1. Busirrcss <br />and PrrfcssionCodc:'l'hcCoillraclor's[-iccnsc[,awdocsnolupplyk)anowncrofpropcrtywhobuil(lsorirtprovcsthcrcon. <br />nnd uho conlracls for such projccls with a (i)nlmchrls) liccnsed lursu{nt lo lhc G)ntrxchr's Liccnsc bw). <br />I urr cxcuil urtJcr Scction . B. & P.C. lbr lhis rcason. <br />Date:_-_ Owner:__._ <br />IY(IRKFILS' COTUPENSATION <br />IIFCLARATION <br />I hcreby affirm undcr pcnalty of pcrjury onc of lhc lbllowing dcclarat krns: <br />-l <br />hrrc and will nraiDtain { Ccflificalc of Conccnt l(, Sclf'lnsurc for ur)rkcrs'coiltFnsxtiotr. !s prol'tlcd for by Sccthn l70O ol thc <br />I-iltx,r Codc. li)r thc pcrl-onnilncc of thc work for which thc pcrmit is issucd. <br />-l <br />havc ond will maintsin workers' comlrnsation insurarce, as rcquired by Section 3700 of the kbor Codc. for lhe Frfotmne of <br />lhc work is My workcr-s' compclstrtion insuraflcc canicr and policy numbcr arc: <br />*14 f ra ncL <br />Policy {9rror{3 I <br />-l <br />cenify lhal in lhc pcrfornuncc of lhc work for which this prmil is issucd. I shall nol employ any Jrcrson in any manrcr <br />s as t) bccom subjecl to lhe workers' comlrcnsation laws of Californi!. arrd agrcc that if I should bcrorc subj(l to thc <br />workers'comlrcnsalionprovisionsofSection3T0OofthcljtsrCodc. lshnll.forthwilhsmplywilhlho*provisions.. <br />WARNING: Frailurc to scure workcrs'mmlrcnsation coverngc is unlawful. and shall subjcct an employcr to qiminal JEnsltics snd <br />civil lincs up to onc hundred thousand dollars ($ion lo lhc cost of comlEnsatt)n. danragcs as providcd for thc <br />Setion 3076 <br />o <br />intcrcst and <br />t l <br />I hcrchy affirm undcr pcnalty of pcrjury thrt I arn undcr prrvision of Ch{pts 9 (commncing with Scction 7000) of Division .1 <br />of lhc Busincss and Pmfessions Code, and my licens is in lull fore ard effect. <br />Liccnsc <br />I hcrchy allirm undcr pcnrlly of pcrjury thul lhcre is a coilslruction lcnding agcncy lirr lhc pcrl(rrilrancc ol thc work li)r which this pcrntit is <br />i\sucd (Scc. .1(197. Civ. C. ). <br />kndcr's Ad,lrcss: <br />APPLICANT DECLARATION <br />I lrreby allinn undcr pcnalty of pcrjury onc of thc f<rlkrwing clcclarations: <br />Dcrnolitir)n Pcrmils-Asbcstos N()lillcalion Fcdcral Rcguliti{)ns (Titlc 40, Parl6) <br />_Rcquirc(l ktlcr r)f Nolilication <br />_l ccflify that thc fcdcral rcgululions rcgeding astEstos rcmovalurc not {pplicuhlc lo this projcct. <br />_l cenify thal I havc rcad lhis application and slale thd the ahrvc infomtion is cor(t. I agre lo comply wilh sll Cily and County <br />ordinanccs and Slate Laws rehting to <br />atxrvc nrntioilcd propcny k,r <br />Applicant or Agent <br />Pemrilee mme <br />aulhorizc reprcscnlatives ofthis City and lo cnlcr upon lhc <br />zlzuDole: <br />l)trte: <br />Lendcr's Nantc: <br />+-